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Hi! My name is Amrita Mani. I am a senior majoring in psychology and minoring in Spanish and chemistry. As a Gil intern, I worked at Threshold Clubhouse, a community-based psychosocial rehabilitation program that focuses on improving the quality of life of adults, or members, with severe and persistent mental illnesses. I was drawn to this organization to explore a novel but necessary part of psychological health advancement for me: advocacy. Since beginning a research assistant position in the Carolina Affective Science Lab, directed by Dr. Kristen Lindquist, I have been passionate about studying social determinants of health such as perceived discrimination and stigma. Working closely to research for the advocacy unit of Threshold has allowed me to learn how members and staff raise the importance of awareness, funding, and support for adults with mental illness, a population historically underfunded and stigmatized.

At Threshold, members participate in a work-ordered day. They volunteer in at least one of the units (kitchen, clerical, and career services) to advance independent living, social/interpersonal, and pre-vocational skills. I’ve had the privilege of working with the executive director, Elizabeth Barber, and other Threshold staff members who are passionate about mental health advocacy through a remote position. The advocacy group’s mission is to get legislators, academics, and service providers in NC to talk more about mental health. The advocacy group convenes every third Monday evening along with state officials and other health and social support organization members to talk about updates to policy and proposals in the state. My first task as an intern was to research and create infographics about key themes and figures in the NC Department of Health and Human Services mental health town halls and NC legislative breakfast. For example, current hot topics include Medicaid expansion/transformation, overflowing emergency departments, and gaps in rural health services. Members can use these themes at meetings as ideas and evidence to put in letters and include in conversations with legislators and representatives to easily discuss gaps in funding and awareness regarding mental health.

Next, I became involved in gathering data about admission and rehospitalization rates at NC’s three inpatient psychiatric hospitals: Cherry, Broughton, and  Central Regional Hospital. To do this, I called each hospital and the offices of NC state representatives directly. This was an interesting challenge. Although I did not have complete success in gleaning answers to every question- due to confidentiality rules- this task demonstrated a small challenge that other advocates face on a daily when working towards their goals. 

Toward the end of my internship, I was lucky to go to Threshold in person. A.J., a current member, gave me a detailed tour of the Clubhouse and taught me about many additional programs such as the community garden, the education room, and the great hall where members can simply socialize and build connections. I also met Ali Swiller, Associate Director, who described the joys and challenges of motivating members to join the workforce and build community, often after growing up being told they couldn’t do numerous things secondary to their health conditions. Furthermore, we discussed how important it is for health professionals to see their patients as people since hospital staff often see patients at their worst. Threshold Clubhouse has allowed me to explore a community-based approach to supporting members with mental illnesses. My favorite part about this organization is that it prioritizes working with members instead of working for members. Each unit is run by members instead of having them take a hands-off approach to their own well-being and growth. Another topic I’ve learned through my internship is the effect of tobacco smoking cessation policies on the functioning of community organizations like Threshold. Asking members to abstain from smoking for an eight-hour workday, like would occur with a state mandate currently set to be implemented in NC in 2025, would likely deter members from attending the Clubhouse. Through a literature review, I was able to explore the social determination theory and its significance in promoting autonomy which is associated with greater self-efficacy, behavior persistence, and more long-term behavior change than forceful cessation. This was an important educational side project where I explored a different perspective on smoking cessation than the positive health benefits perspective I had previously exclusively known.

As an aspiring physician, this internship has shown me a non-clinical side of psychological health rehabilitation and maintenance that puts the member at the forefront of their health and wellbeing. In medicine, patient autonomy is crucial in instilling respect and empowerment. My mentors, Ali and Elizabeth, are wonderful advocates of promoting this autonomy for members and extending their voice to broader Durham county and state levels through various training sessions and meetings they lead. Through my background research, I have been able to support members and staff by providing them with evidence to cite during their advocacy meetings. Overall, it has made me excited to keep working for mental health advocacy while a student and during my career in primary care. There is much work to be done to fight the stigma against adults with mental illnesses to empower instead of isolate them, and I am excited to keep learning and working from this advocacy standpoint that Threshold introduced to me! Thank you to Elizabeth and Ali at Threshold Clubhouse for including me in their projects and to Emily Dolegowski and Dr. Buzinski for providing me with the opportunity to be a Gil intern!


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